Provider Demographics
NPI:1619092897
Name:PHILLIPS, DAVID (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 GANTTOWN RD
Mailing Address - Street 2:BUNKER HILL CTR, STE 106
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-1888
Mailing Address - Country:US
Mailing Address - Phone:856-582-7707
Mailing Address - Fax:856-582-8055
Practice Address - Street 1:432 GANTTOWN RD
Practice Address - Street 2:BUNKER HILL CTR, STE 106
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1888
Practice Address - Country:US
Practice Address - Phone:856-582-7707
Practice Address - Fax:856-582-8055
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC001860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44938Medicare UPIN
NJ431907Medicare PIN